Barbara Robb

and

Sans Everything:

50 years onCLAIRE HILTON

2017

Powick Hospital: Ward F13 (1968)

https://www.youtube.com/watch?v=UzjeBaBFWqw

Then and now

The work of Barbara Robb (1912-76)

her book Sans Everything (1967)

the outcome of her campaign (1965-75)

and why it is relevant today…….

abuse continues

overcrowding

overcautious supervising

whistle-blowers and whistle-blowing

Barbara: in the driving seat

Women role models in her

family….

a Catholic martyr

an opera singer

a magistrate

campaigners

authors

Aunt Ernestine - in first ever Yorkshire women’s cricket team.

With grandfather Ernest c.1922

‘when you see somebody needing help - help him.’

Then once, when I was a little girl, I got stung by

nettles. He told me that wherever there were nettles

there were sure to be dock leaves to cure the sting.

And then he said: ‘Remember that everything in life is

like the nettles, there are always dock leaves if only

you look hard enough.’

----------------------------------

Later, Barbara trained in Jungian psychotherapy.

Jung said: ‘she decidedly leaves you guessing’

Amy Gibbs and Friern Hospital

I would never have

another really easy

moment unless I did

everything I could to try

to right this situation.

---------------------------

Founded AEGIS:

Aid for the Elderly in

Government Institutions

Lord Strabolgi, 1965…

… an atmosphere of humiliation and

neglect. The patients are … ‘pulped’.

They lose all sense of self-respect.

Worse than this, many are cowed and

frightened. All just vegetate and seem

lost to the world. And they are lost to

the world. There is nothing more

relentless than the State machine when

it gets the helpless into its maw.

The White Paper

‘would simply demolish Mrs Robb’

Kenneth Robinson, 1968:

I deeply regret the anxieties which

have been caused … by the

publication … of so many allegations

which are now authoritatively

discredited…

… the publication of the White Paper

should discourage anyone from

making … ill-founded and irresponsible

allegations in future.

NHS changes influenced by Barbara

1969-76Richard Crossman, 1969-70

Openly visited hospitals to draw press attention to them

Condoned newspapers smuggling journalists into hospitals

Established Hospital Advisory Service

Allocated long stay hospitals more money

1969-74 Other inquiries, showed deficits

1971-2 Plans to improve mental illness (older and younger) and

‘mental handicap’ services

1971-3 Review complaints procedures

1973 Ombudsman

1976 First guidance on managing violence in hospitals

… and 50 years on …?

Overcrowding in 2017?

Too rapid throughput, patients discharged

before well enough = a pernicious form of

overcrowding, in time rather than space.

Managers proud of rapid throughput,

assume it indicates effective treatment in

a shorter time, so lower cost.

If staff levels calculated by bed numbers

rather than activity, staff under pressure

may carry out tasks, but neglect real care.

Ely Hospital 1969

Complaints, criticisms and

over cautious supervising

1960s: rigid management, strict obedience to seniors

2010s: strict clinical protocols or ‘care pathways’

Top-down quantitative monitoring, associated with mechanistic, task-

driven practice

Difficult to deviate from pathways deemed to be correct

Don’t fit with individual’s care needs

Risk of objectifying and dehumanising person receiving care

Demotivate staff and stifle creativity

HOW MUCH DOES TIGHT MONITORING AND CONTROL RAISE STANDARDS?

Scandals and whistleblowing

Factors identified in scandals of care since 2010:ageist attitudes

under-resourced and target-driven

cultures of blame

whistle-blowers scapegoated

institutional secrecy, despite duty of candour

Nursing Mirror survey, 1967, fear of speaking out…

National NHS Staff Survey, 2015: ‘unsafe’ clinical practice, would staff

know how to report concerns? 86% yes

feel secure in raising them? 70% agree

confident that their organisation would address them? 56% agree

Lessons on whistle-blowers

New staff with minimal training often

had most insight into the humanity

and quality of the care provided.

New staff and students are least

likely to be asked their views on

standards of practice.

The ‘new eyes’ effect is under-

utilised.

Barbara Robb 50 years on...

Barbara made a huge impact in her time

Understanding her work contributes to policy agenda today

50 yrs since Sans Everythingand 40 since Barbara died, it is fitting to recognise her place in the history of the NHS.

Barbara and Brian Robb 1972

The Book!

Open access – free on line,

Palgrave Macmillan, later in 2017.

Thank you.